A Palestinian child carries a ball and bird cage as he walks on the rubble of a building close to the Rafah refugee camp in southern Gaza on Aug. 4, 2014. / Mahmud Hams, AFP/Getty Images

by Yousef Al-Helou and Jennifer Collins, Special for USA TODAY

by Yousef Al-Helou and Jennifer Collins, Special for USA TODAY

GAZA CITY - Gazan children picked among the rubble of their former homes during a three-day cease-fire, searching for toys and notebooks that may have survived the four-week bombardment of the coastal territory.

The children are full of questions that no one can answer - mainly, what's next?

"Our house was attacked - where am I going to sleep now? We have no home," said Yasmin, 6, in Gaza City, whose last name was withheld to protect her privacy. "I miss my bed and decorated room, I wish it was still there and our home was not targeted."

Some 40,000 homes have been damaged or destroyed during the month-long conflict with Israel that has displaced nearly half a million Palestinians and killed nearly 1,900 - more than 400 of them children, according to Gaza's Public Works Ministry and Health Ministry.

The United Nations has condemned Israel for its attacks, especially those near U.N. schools being used as shelters, where dozens have been killed in recent weeks. On Sunday, the State Department called on Israel to do "more to meet its own standards and avoid civilian casualties."

In Gaza, those younger than 18 make up slightly more than half of the territory's nearly 2 million inhabitants and as a result, children have borne the brunt of fighting, leaving many deeply traumatized after their third war in six years, aid workers say.

"We estimate that there are at least 373,000 children who need psycho-social support at the moment ... either because they have experienced the death or injury of their parents or of family members, or because they have lost their homes - and of course the trauma of moving away from your home," said Joseph Aguettant, country representative for Palestine with the Swiss foundation Terre des hommes, which runs projects to fight child labor and provides support services to kids.

Children are showing symptoms of distress - clinging to their parents, suffering from sleeping and eating disorders, nightmares and nervousness, as well as feelings of guilt and anger - all compounded by the "realization that there is no guaranteed safe space in Gaza," according to the U.N. Office for the Coordination of Humanitarian Affairs.

Parents say the sound of explosions and shelling have left their children shaking in fear.

"My children would shiver and run towards me and their mom and cry most of the time when they heard a loud of explosion," said Motasem Ghattas, 33, from the heavily bombed Shijaiyah neighborhood in Gaza. "Our children were subjected to horrendous fear, the sound of bombs negatively affecting their nerves. It breaks my heart when they jump and scream."

The latest war in Gaza has had a bigger impact on kids than the 2012 and 2008-09 conflicts because of its duration and the number killed and displaced, said Majeda Al Saqqa from the Gaza-based Culture and Free Thought Association (CFTA), which provides therapy and other pyscho-social support services to children.

The Palestinian Center for Human Rights estimates 1,434 Palestinians - 288 of those children - were killed in the three-week 2008-2009 war. In the week-long 2012 offensive, 34 children were killed with an overall death toll of 160. Israeli death toll estimates are lower.

"Each war is ugly (but) this one is intense, this one is big for children â?? the number of children who have been killed, the number of children who are disabled now, the number of children who lost their family â?? it's huge," Al Saqqa said.

Many children have gone days without eating because of food shortages, and U.N. agencies are overwhelmed with those seeking shelter, Al Saqqa added.

Of the estimated 2,882 children Gaza health officials say have been injured, many have not been able to reach hospitals and those who have often do not get sufficient treatment due to lack of medical supplies and outdated equipment.

Dr. Mads Gilbert from Norway came to Gaza at the start of the Israeli offensive to volunteer to treat wounded children at Shifa Hospital. Many of the multi-trauma patients require advanced equipment and expertise not available in Gaza and need to be transferred abroad, he said.

Local and international organizations such as CFTA, Terre des Hommes and the Gaza-based Palestine Trauma Center are continuing to provide medical, psychological support and trauma counseling to Gaza's children - as they have done for a number of years there.

"We do on the ground psycho-social counseling for those most affected," Aguettant said. "But also activities with children such as creative and movement activities, games, sports. Simply, the possibility for children to express their feelings, to draw, to talk in circles."

But as parents dig through the rubble of their former lives and with no guarantee of a lasting peace in Gaza, many wonder what the future will hold for their kids.

"My 7-year-old daughter is experiencing her third war at her age," said Younis Sukker, a 28-year-old father of four from Gaza City's Toffah quarter. "What kind of future can she and the other children of Gaza have?"